2014: Opening the Oregon Health Plan to more people
Providing health care coverage for low-income Oregonians
What is happening
In January 2014, the Oregon Health Plan (OHP) will be available to more low-income adults. Many of these adults are uninsured and work part-time or in low-wage jobs without access to health insurance.
What it means
More low-income Oregonians will have access to health care coverage, providing them better access to care and more financial stability. Medical debt to providers will be reduced.
- No more waiting list for the Oregon Health Plan.
- Income limits are changing. Today the income limit to qualify for the Oregon Health Plan is very low. A person’s income must be at or below 100 percent of the Federal Poverty Level (FPL) to qualify. Starting in January, coverage will be available to people who earn up to 138 percent of FPL. That’s about $15,800 a year for a single person or $32,500 a year for a family of four.
Why this is happening
In 2013, Governor Kitzhaber and the state Legislature approved opening OHP to more low-income Oregonians as allowed under federal health reform. This means that working families will have the high-quality health coverage they need, when they need it, through OHP.
How to apply for OHP or commercial insurance
Cover Oregon is an online marketplace where Oregonians can apply for health coverage. Beginning in October 2013, anyone regardless of income can apply online at www.coveroregon.com. Cover Oregon will include the Oregon Health Plan, Healthy Kids and private insurance plans that begin in January 2014.
Paper applications will be available in multiple languages, and community partners will be available to help people with the application if needed. Help is also available by calling 1-855-CoverOR (1-855-268-3767) or at all Oregon Health Authority and Department of Human Services offices.
Financial assistance paying for private coverage
Based on household size and income, some Oregonians may qualify for no-cost health coverage through the Oregon Health Plan. Others may qualify to get help paying for private health insurance. A family of four that earns between $32,499 and $94,200 a year may qualify to get help paying for private health insurance through Cover Oregon. This includes help paying for insurance premiums and out-of-pocket costs like co-pays and deductibles. Financial help could come in monthly payments or a lump sum when an individual or family files their taxes.
Coordinated care – the Oregon difference
In Oregon we have taken a bi-partisan approach to improve the health care system. Most people on the Oregon Health Plan are served by a local “coordinated care organization.” These organizations bring together all aspects of care: doctors, hospitals, dental care, mental health care and public health.
Coordinated care organizations work for better health, better care and lower costs by focusing on prevention, chronic disease management, earlier interventions, and reduction of waste and inefficiency in the health system.
Coordinated care organizations are required to meet quality standards or “metrics” that are posted publicly four times a year. The Oregon Health Authority uses these metrics to assess CCOs on how well they are doing in key areas such as access to care, prevention and health screenings, mental health care, and many other metrics.
Under an innovative agreement with the federal government, Oregon will reduce waste and inefficiency in health care and create a more sustainable system. This will allow us to hold down per capita costs while providing better care.
The number of people expected to qualify
Projections show about 180,000 low-income Oregonians who are currently uninsured could have health coverage through OHP by 2015. Ultimately, 240,000 additional people could be covered through OHP by 2016.
How it will be funded
For the first three years (2014 through 2016), federal funds will pay 100 percent of the costs for people who are eligible under the increased income limit. Federal funding will gradually decline, about two percent a year, to 90 percent in 2020 where it will remain.